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Untouchable?

Thursday, November 1, 2012

Thirty-seven years into the War on Drugs, the 2012 United Nations World Drug Report says the rate of reported cannabis use in Oceania (essentially Australia and New Zealand) is between 9.1–14.6 percent – the highest in the world. But its possession and use remain illegal. Hundreds of thousands of police hours and more than a $100m a year go into enforcing that. Is it worth it? With the government promising to overhaul drug law during this parliamentary term? Penny Mackay tried to find out.

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It’sbrisk business on a Tuesday morning at Wellington Hospital emergency department. A cyclist hit by a car in the centre of the city, a baby who won’t stop crying, a skateboarder who’s taken a tumble. Specialist Paul Quigley takes a few moments away from the frontline to talk about the number of presentations directly related to cannabis that he sees in ED. That would be virtually none, he says. He’s more likely to see presentations relating to the side effects of criminalising the drug.

“Like the violence, say at the tinny houses, perhaps because someone cannot pay up or there’s involvement in theft and other crime. And we see the effects of some of the social deprivation that goes on as well because of the elevated prices.”

By comparison, he sees plenty of people suffering the effects of alcohol and nicotine.

“It’s about 500 alcohol presentations to every one drug presentation, whether that be opiates, benzos or street drugs. And then there’s all the nicotine-related presentations – heart disease, lung disease, vascular disease, the cancers…”

But Quigley is quick to point out that the very act of smoking cannabis is not without hazards and can lead to mouth, lung and tongue cancer, as well as emphysema. It’s all very well to justify smoking cannabis by saying ‘Well at least I’m not smoking tobacco’, but the smoke harm, he says, is just as bad.

Care NZ would agree the drug is hardly benign. The organisation provides addiction treatment to about 5,500 people a year, including prisoners. Its Chief Executive, Tim Harding, says the dependence that heavy users of cannabis can develop often becomes apparent only when they try to give up.

“People go through the first week thinking ‘This is no big deal, it’s a piece of cake,’ but during their second week, he says, where they have been used to the sedative effect of it in their system, they’re clutching their seat and bouncing off the walls. They are not enjoying themselves at all. It’s very psychological, but it has physical aspects as well. They’re agitated, there’s huge craving. People who say there is no withdrawal from cannabis obviously haven’t worked in the services I’ve worked in.”

Tim Harding says Care NZ’s school programmes indicate that cannabis is the drug of choice of 64 percent of those 15-year-olds and younger that have a substance dependency. That reduces to just 12 percent of clients 51 to 60-years-old, but he says that doesn’t mean cannabis use is simply a rite of passage.

“Many of them may eventually give it up, but by then they may’ve completely disengaged with education, they’re suffering mental health problems and have other health issues. We mustn’t underestimate the effect this has, particularly when they are growing up.”

Research from the University of Otago longitudinal study of more than 1,000 New Zealanders born in Christchurch in 1977 indicates that regular, heavy cannabis use is associated with a significantly increased risk of psychosis.

Adding weight to those findings, a leading British professor of psychiatry, Robin Murray, says about a quarter of the population has a gene that makes them prone to psychosis if they regularly use cannabis in adolescence. He says that New Zealand’s rate of cannabis-related schizophrenia is about 8 percent.

While devastating to the cannabis user and their family, the addiction psychiatrists at Wellington’s Community and Alcohol Drug Service, Drs Jeremy McMinn and Tom Flewett, believe the incidence of cannabis-related psychosis should be kept in context. They say 80 percent of their work is related to alcohol problems, and very few clients arrive with a cannabis-related mental health issue.

These measured, quietly spoken doctors, who see some of the worst effects of drug addiction, say they speak on behalf of all their colleagues around New Zealand when they say drug prohibition has been a failure. Decriminalisation will not, they say, lead to ‘chaos, illness and crime’ and would in fact make their practice easier. At present, they have trouble getting some clients to engage with treatment. As they observe soberly, if someone is participating in an illegal activity, they are unlikely to feel freed up to talk about it.

A leading 2010 British study concluded there was no logic to official drug classifications, which purport to rank them according to the harm they cause. Two independent groups of experts looked at the personal and social harms caused by 20 drugs and found alcohol to be overall the most dangerous drug, ahead of substances like heroin and methamphetamine. Nicotine was sixth most harmful and cannabis eighth.

So why are alcohol and nicotine legal and cannabis not?

The head of Victoria University’s Institute of Criminology, Associate Professor Julian Buchanan, says drug laws of western countries are based on the United Nations Single Convention on Narcotic Drugs 1961. He says many of the people who wrote the convention drank alcohol and smoked tobacco. “They just did not see alcohol and tobacco as ‘substances’. But the people who were using opium, largely Asian people, and those using cannabis, largely people from a black African background, were perceived as outsiders and a threat to the mainstream. So the reasoning behind the convention is really an enmeshment of discrimination as well as ignorance.”

And Dr Buchanan says the inertia of successive governments to remediate that is largely due to politicians wanting to be seen as tough on drugs. “It’s a sort of a punitive populism with politicians framing drugs as the ‘enemy within’. A declaration of war on that enemy is a major vote winner, it really is as simple as that.”

In New Zealand, someone caught by the police with a small amount of cannabis can be sentenced to two years in jail, larger amounts eight years. But the National Crime Manager Detective Superintendent Rod Drew explains that between being caught, and possible imprisonment, stands the judgement of the individual police officer. He says officers’ discretion is one of the cornerstones of policing in this country and allows for a range of responses to the discovery of someone’s stash, including a warning and diversion through to full arrest and prosecution.

But last year’s Law Commission review of the Misuse of Drugs Act 1975 said, while police discretion does offer the opportunity for a proportional response, it also allows for unfairness, discrimination and uncertainty.

Defence lawyer and leader of the Aotearoa Legalise Cannabis Party Michael Appleby also finds convictions relying on judges’ discretion unsatisfactory. He says a ruling sometimes depends on whether or not the defendant is appearing before a rural or urban judge and can also depend on the age of the judge.

“I know for a fact there are judges who have smoked cannabis, MPs who have smoked cannabis, there are Crown prosecutors who have smoked cannabis, there are Queen’s Counsel who have smoked cannabis. But of course they don’t get caught because it is done discreetly.”

Former undercover drugs officer and now defence lawyer Tony Bouchier worries about the lost opportunities when young people do get caught and then convicted.

“There is a huge economic argument about the imposition of a criminal conviction on someone for drug use because all it’s going to do is result in them not taking the same full part in the community that they could have done without that conviction.”

A Massey University study released in April found that arrests for cannabis possession had halved since 1991. But Rod Drew rejects any suggestion that figure indicates a move towards informal decriminalisation. He points to an increase in the number of arrests for cannabis possession and cultivation between 2008 and 2010. The vast majority of those arrests ended in prosecution.

“We recognise very strongly that cannabis use is an issue in New Zealand. We have very high cannabis use here, and we also know there are very strong links to organised crime with cannabis and other

drugs. We have concerns in regard to burglaries and other crimes there are lots of where there is a cannabis element. We also have real concerns in relation to the drug dealing or tinny houses where we often find children. These are very unhealthy environments for them to be in.”

When asked if the police are winning the 37-year-old War on Drugs, Rod Drew says there needs to be a “longer-term look” at enforcement but believes the police are “doing well”. He does not say the police are winning the war.

Raids come at a price. New Zealand economic research company BERL found police enforcement of cannabis activities cost $116m in 2005–2006 and accounted for 334,000 policing hours. And yet Law Commission findings are that about a third of 18 to 24 year-olds are current cannabis users.

Such statistics lend support to the view that prohibition has failed. But does that justify freely launching a third drug, after alcohol and nicotine, onto the New Zealand community?

Phil Saxby from the National Organisation for the Reform of Marijuana Law (NORML) advocates for cannabis to be legalised and bought and sold in a regulated taxable market. Rather than being a drain on the state in enforcement costs, housing prisoners, deaths and injuries, he says, cannabis sales could help support the state.

“I’m not going to argue that taxing the system is going to solve all the problems. We would still have drug issues in New Zealand, but it wouldn’t all be a drain, at least some tax money would be coming back in.”

But Associate Minister for Health, Peter Dunne says changing the legal status of cannabis would mirror what is happening now with alcohol.

“Why open Pandora’s Box? There are problems associated with our current control strategies, and I freely concede that. But I think they are minimal compared with the bigger problems that you would have if you said, ‘Well, the way to control this problem is to effectively have no control’.”

President of the Secondary School Principals Association Patrick Walsh agrees. He says that, in the mind of a teen, decriminalising cannabis is sanctioning it as acceptable. He likens the ensuing problems to what happened with the synthetic version, Kronic, where he says there was a huge uptake by students, with some ‘disastrous’ consequences.

And Patrick Walsh says what can happen to students who regularly smoke cannabis is too serious to dismiss. [See Cannabis Use and the Disappearing IQ Points below.]

“They become aggressive, they have short-term memory loss. Nurses and teachers report regular users are unmotivated, lack energy and sometimes have poor judgement. Students can also lose interest in sport and can become socially isolated.”

So what is the experience of other countries that have changed their laws?

Many speak of the Portugal model where, in 2001, possession of all drugs was decriminalised, although supplying them remained an offence. Chief executive of the Drug Foundation Ross Bell describes its success.

“At the same time, they put in what was essentially an arrest-referral system where, if the cops picked you up, you appeared before some experts who assessed you, and if you were drug dependent, you went to treatment. If you were not dependent, there would be some kind of civil sanction. Portugal also invested heavily in drug treatment services.”

A measured analysis from the University of New South Wales found that decriminalisation in Portugal led to a short-term increase in experimental use, but problematic drug use, drug-related harm and jail overcrowding all reduced.

In the Netherlands, decriminalisation, 36 years ago, of possessing small amounts of cannabis gave rise to the coffee shop culture where people could smoke dope without fear of arrest.

Tony Bouchier, who is of Dutch descent, regularly visits the country and says there is “life after cannabis decriminalisation”. He says the worries New Zealanders have about loosening marijuana law have not been exhibited in the Dutch community.

While New Zealanders appear divided on what to do about cannabis law, most seem to agree on one possible change: moving possession and use from being a criminal justice issue to one of health. The idea is supported by NORML, the Law Commission and many in the drug treatment, justice and health sectors.

Care NZ’s Tim Harding is one of them.

“Why not continue to send a very strong and clear message that cannabis use is destructive? But at the same time put in mechanisms so that people who get caught get sent towards health rather than criminal justice. There is seldom a gain in putting someone into the justice system, but there is tremendous gain if you can put them in front of the right people to talk to them about their cannabis use.”

But what about the burden on an already overstretched health budget? Ross Bell says the state swaps priorities.

“Of course, channelling people towards health would take a lot of resources, but if we are propelling fewer people through the very expensive criminal justice system, we can shift that money into interventions that really work.”

Associate Minister Peter Dunne says, in line with the government’s official drugs policy of harm minimisation, $1.2m is spent each year on drug education and health promotion.

But as for moving it from criminal justice to health, Mr Dunne says the law is the law and New Zealand must comply with its international obligations under the UN Single Convention on Narcotics 1961.

The UK charitable think tank, the Transform Foundation, says policy makers have used prohibition as a smoke screen to avoid addressing the social and economic factors that lead to problem drug taking. Ross Bell says the examination by the World Health Organization of drug laws of different countries would seem to back that up.

“They found that countries with tough drug law did not necessarily have low drug use. But there were countries with tough drug law that did have low drug use. So what they concluded was that drug law has little influence over drug use per se. But there are these bigger social issues that need to be looked at.”

So what are the government’s priorities in dealing with cannabis use? Peter Dunne says during this parliamentary term an obsolete drug addiction Act will be replaced. A new regime is to be introduced to put the onus of proving synthetic psychoactive substances are safe on their producers, making party pills and their like illegal until officially approved by the Ministry of Health.

The overhaul of the Misuse of Drugs Act is on its way. Dunne’s office says it will progress next year, with the review of the National Drug Policy and the Law Commission’s review feeding into it. In recent times, the emphasis has been on addressing the need for a psychoactive substances regime.

But, Dunne insists, as does the Minister for Justice Judith Collins, cannabis law will remain untouched.

Medical Marijuana

If there is any official loosening of cannabis law, it will perhaps come first in the medical area.A Golden Bay woman was recently discharged without conviction for growing cannabis to relieve her amputee husband’s pain. Defence lawyer Michael Appleby and leader of the Aotearoa Legalise Cannabis Party says the Golden Bay case is an example of judges taking more personal factors into account.

“I think the judge acknowledged that the consequences of a conviction would be out of all proportion to the gravity of the offence. And what he was doing was just heeding what the High Court has stated in Jackson, a Christchurch case, that, when people do use cannabis for medicinal purposes, then the ‘sin’ is much less serious.”

Medicinal cannabis is in fact available in New Zealand, under the brand name Sativex.

But for any use other than to reduce spasms in multiple sclerosis, doctors must complete a great deal of paperwork, get approval from the Health Minister to prescribe it and complete follow-up observations. For the patient, it costs about $1,000 for a month’s supply.

The organisation leading the charge to make medicinal cannabis legally and easily available, GreenCross, says that is way beyond the budget of virtually everyone.

The head of GreenCross, Billy McKee, says his organisation advocates for a regime similar to that in 16 US states where people can apply to possess or grow a limited number of plants for their own use.

McKee, an amputee after being knocked down by a car in 1975, says he had big trouble with medication prescribed by his doctors for the constant pain of damaged nerve endings. He says

it left him with side effects like nausea so severe he was unable to function day to day.

“So I started using cannabis, and it worked really well. I could get a good night’s sleep and I could wake up in the morning with a clear head. I also used it as a poultice. If I had to walk on my stump and it got really sore, I just put some cannabis on, and within 20 minutes, I could get to sleep, which is quite fantastic.”

Billy McKee says mainly elderly women belong to GreenCross as they are fearful of going near the gangs that sell the drug. Instead, they have come to him in the past for their supply. The former mechanical engineer is now facing four charges of supplying cannabis and one charge of growing it and was due to face trial in late October.

Ben, who is an amputee as the result of a blood disorder, smokes cannabis because the opiates prescribed to him leave him groggy and a “danger on the road”. He plays basketball with 22 other wheelchair users and every one of them smokes weed to get to sleep and to ease pain. He says just three smoked before they became disabled. Ben is fed up with ridicule and judgement and being made to feel like a criminal and having to deal with the gangs. He wants medical cannabis to be made freely available.

But Associate Health Minister Peter Dunne has already ruled out even clinical tests on cannabis leaf, citing the availability of Sativex.

Cannabis use and the disappearing IQ points

Latest research from Otago University has established a link between frequent, long-term cannabis use and diminishing intellectual function.

Researchers in the Dunedin Longitudinal Study had tested the IQ of the 1,000 participants in their teens and found last year that among the now 38-year-olds who had smoked cannabis long term and often, there was an average loss of 8 IQ points.

“That’s substantial,” says research leader Richie Poulton. “Such a loss would impair what is known as ‘executive processing’; the ability to plan, make judgements, the speed of information processing and the capacity to comprehend information.”

Those most at risk began using cannabis before 18 years of age and were continuing to smoke it more days than not, 20 years later.

“It is not a case of one specific cognitive function being affected and others left intact. The effects are pervasive, and that is even more concerning.”

The study sent questions to people nominated by the 38-year-olds: do they have problems with memory or attention, do they have trouble remembering names, do they go to the shops and forget why they are there or fail to keep an appointment? How difficult is it for them to follow an argument or discussion, how difficult is it for them to attend to issues at hand, how easily are they distracted?

“If someone starts out with an IQ of 150 in their teens, the loss of 8 points isn’t going to make a big difference. But if they have an IQ of 100, which is the average, they go from being in the 50th percentile or halfway through the population, to the 29th percentile, which means they are near the cusp of the bottom quarter of the population – certainly they’re in the bottom third.

“Of course, some IQs will have dropped less than 8 points, some more. So if you accept that our 1,000 study members are an approximate representation of the general population, there are a number of people in the New Zealand community who will be really struggling because of sustained cannabis use,” says Professor Poulton.

He says it’s important to realise the conclusions are about a small number of cannabis users who can get into trouble, not about the person who has the odd joint.

“But for those it does affect, the consequences are significant. IQ predicts length of education, type of jobs likely to be won, jobs performance, as well as physical health like inclination to dementia, cardiovascular health and even how long you live.”